Stroke

Question 1

Major risk factors for stroke

Answer 1

Hypertension, heart disease, previous stroke, DM, smoking, age

Question 2

Ischemic stroke

Answer 2

Thromboembolism, low blood flow to focal part of brain. Accounts for 85% of strokes.

Question 3

Layers of ischemia?

Answer 3

Core, penumbra, benign oligemia. Penumbra is still salvagable

Question 4

Target layer of acute stroke therapy?

Answer 4

Penumbra

Question 5

Limb involvement with ACA and MCA stroke?

Answer 5

ACA- leg

MCA - arm and face

Question 6

Are anterior or posterior circulation strokes more common?

Answer 6

Anterior. MCA more common than ACA

Question 7

Syndrome with left dominant stroke

Answer 7

Aphasia, L gaze preference, R visual field deficit, r hemiparesis, R hemisensory loss.

Question 8

Syndrome with right hemisphere stroke

Answer 8

Neglect, R gaze preference, L visual field deficit, L hemiparesis, Lhemisensory loss. Bad rehab candidates because of the neglect (dressing apraxia)

Question 9

Syndrome with internal carotid artery occlusion

Answer 9

Produces both ACA and MCA syndromes. May be preceded by amaurosis fugax

Question 10

Amargosis fugax

Answer 10

Transient monocular vision loss

Question 11

Syndrome with PCA stroke

Answer 11

Contralateral homonymous hemianopsia with macular sparing. If on dominant side, get Alexia without agraphia, if bilateral –> anton’s syndrome (can’t see but don’t know)

Question 12

Decreased consciousness with brainstem stroke?

Answer 12

Yes, because bilateral reticular formation knocked out.

Question 13

Cerebellar infarction

Answer 13

Good prognoses for survivors, can develop life-threatening edema though.

Question 14

Ventral pons lesion?

Answer 14

Locked in syndrome

Question 15

TIA

Answer 15

Transient ischemic attack, reversible focal dysfunction, reversible and lasts less than 24 hours. Increases risk of stroke

Question 16

Subarachnoid hemorrhage

Answer 16

Bleeding around brain, can be caused by ruptured aneurysm, AVM. Surgical emergency.

Question 17

Symptoms of subarachnoid hemorrhage

Answer 17

Headache, neck stiffness, neck pain, light intolerance, nausea, vomiting.

Question 18

Diagnosis of SAH

Answer 18

CT or LP needed.

Question 19

Berry aneurysm

Answer 19

Congenital weakness at branch points in circle of willis. Most common is ACA (40%), causes abulia

Question 20

Mycotic aneurysm

Answer 20

Due to infection, generally occurs in the middle of nowhere. Not a point in the circle of willis

Question 21

Posterior communicating artery aneurysm causes

Answer 21

IIIrd nerve palsy

Question 22

Intracerebral hemorrhage

Answer 22

Bleeding into brain tissue, usually caused by chronic hypertension

Question 23

Hemorrhage sites due to hypertension

Answer 23

Thalamus, putamen, caudate (big trouble)

Pons cerebellum

Question 24

Acute ischemic stroke treatment options

Answer 24

6 hours mechanical clot extraction
3-6 IA TPA
<3, IV TPA

Question 25

Drawback of IV ischemic stroke treatment?

Answer 25

Increased risk of ICH, reperfusion injury

Question 26

Does aspirin help?

Answer 26

Yes, sometimes more than warfarin.